Provider Demographics
NPI:1497910855
Name:ROSENDO I INTENGAN MD
Entity Type:Organization
Organization Name:ROSENDO I INTENGAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSENDO
Authorized Official - Middle Name:I
Authorized Official - Last Name:INTENGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-882-2424
Mailing Address - Street 1:1275 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2412
Mailing Address - Country:US
Mailing Address - Phone:716-882-2424
Mailing Address - Fax:
Practice Address - Street 1:1275 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2412
Practice Address - Country:US
Practice Address - Phone:716-882-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00613561Medicaid